Masked bolus gluten challenge low in FODMAPs implicates nausea and vomiting as key symptoms associated with immune activation in treated coeliac disease. Issue 2 (26th November 2019)

• Record Type: Journal Article
• Authors: Daveson, A. James M.; Tye‐Din, Jason A.; Goel, Gautam; Goldstein, Kaela E.; Hand, Holly L.; Neff, Kristin M.; Williams, Leslie J.; Truitt, Kenneth E.; Anderson, Robert P.
• Other Names: Adams A. investigator.; Andrews J. investigator.; Behrend C. investigator.; Brown G. investigator.; Hospital Alfred investigator.; Chen Yi Mei S. investigator.; Coates A. investigator.; Daveson A.J.M. investigator.; DiMarino A. investigator.; Ee H. investigator.; Elliott D. investigator.; Epstein R. investigator.; Feyen B. investigator.; Fogel R. investigator.; Friedenberg K. investigator.; Gearry R. investigator.; Gerdis M. investigator.; Goldstein M. investigator.; Gupta V. investigator.; Holmes R. investigator.; Holtmann G. investigator.; Idarraga S. investigator.; James G. investigator.; King T. investigator.; Klein T. investigator.; Kupfer S. investigator.; Lebwohl B. investigator.; Lowe J. investigator.; Murray J. investigator.; Newton E. investigator.; Quinn D. investigator.; Radin D. investigator.; Ritter T. investigator.; Stacey H. investigator.; Strout C. investigator.; Stubbs R. investigator.; Thackwray S. investigator.; Trivedi V. investigator.; Tye‐Din J. investigator.; Weber J. investigator.; Wilson S. investigator.;
• Is Part Of: Alimentary pharmacology & therapeutics. Volume 51:Issue 2(2020)
• Page Start: 244
• Page End: 252
• Publication Date: 2019-11-26
• Subjects: Digestive organs -- Diseases -- Treatment -- Periodicals; Digestive organs -- Effect of drugs on -- Periodicals; Gastrointestinal system -- Diseases -- Treatment -- Periodicals; Gastrointestinal system -- Effect of drugs on -- Periodicals; 615.73
• DOI: 10.1111/apt.15551
• Languages: English
• ISSNs: 0269-2813

Abstract

Summary: Background: In patients with coeliac disease, FODMAPs in gluten‐containing foods, and participant anticipation of a harmful ('nocebo') effect, may contribute to acute symptoms after gluten challenge. Aim: To establish acute gluten‐specific symptoms linked to immune activation in coeliac disease Methods: We included 36 coeliac disease patients on a gluten‐free diet receiving placebo in the RESET CeD trial. Double‐blind, bolus vital wheat gluten (~6‐g gluten protein) and sham challenges low in FODMAPs were consumed 2 weeks apart. Assessments included daily Coeliac Disease Patient Reported Outcome (CeD PRO) symptom scores (0‐10), adverse events and serum interleukin‐2 (baseline and 4 hours). Results: Median CeD PRO score for nausea increased most (sham: 0 vs gluten: 5.5; P < .001). Apart from tiredness (1 vs 4, P = .005) and headache (0 vs 2, P = .002), changes in other symptoms were small or absent. Only nausea increased significantly in occurrence with gluten (11% vs 69%, P < .001). Without nausea, only tiredness and flatulence were common after gluten. Nausea (6% vs 61%, P < .001; median onset: 1:34 hours) and vomiting (0% vs 44%, P < .001; 1:51 hours) were the only adverse events more common with gluten than sham. Interleukin‐2 was always below the level of quantitation (0.5 pg/mL) at baseline, and after sham. Interleukin‐2 was elevated after gluten in 97% of patients (median fold‐change: 20), and correlated with severity of nausea ( rs = .49, P = .0025) and occurrence of vomiting ( P = .0005). Conclusions: Nausea and vomiting are relatively specific indicators of acute gluten ingestion, and correlate with immune activation. IBS‐like symptoms without nausea are unlikely to indicate recent gluten exposure. Abstract : LINKED CONTENT This article is linked to Gibson and Daveson et al papers. To view these articles, visit https://doi.org/10.1111/apt.15620 and https://doi.org/10.1111/apt.15629 .